DR. MARTIN SCURR: Can taking antihistamines harm me in the long run?

I have had sleeping problems for years, but taking an antihistamine tablet (cetirizine) a few nights a week really helps. But the pills make me a bit drowsy, and can they do any harm?

Tina Vowles, Gloucestershire.

Not all antihistamines are the same. There are two types: sedating and non-sedating.

Dr. Martin Scurr responds: Antihistamines work by targeting histamine receptors. Histamine is a chemical the body produces in response to a perceived threat (in the case of an allergy, the mistaken perception of a harmless substance as a threat). The symptoms are the body’s way of trying to get rid of it (like sneezing).

However, histamine also plays a role in wakefulness, so an antihistamine can make you feel sleepy.

However, not all antihistamines are the same. There are two types: sedating and non-sedating.

The former can reach the brain better (due to the way they are transported by the blood). An example of this is chlorphenamine (brand name Piriton).

The cetirizine you are taking does not have a sedative effect. However, some people find it drowsy. You seem to be one of them.

Long-term use of antihistamines has been linked to dementia. It is important to stress that this is not a proven cause, but the risk appears to be because some antihistamines are anticholinergics.

Long-term use of antihistamines has been linked to dementia. It is important to stress that this is not a proven cause, but the risk appears to be because some antihistamines are anticholinergics, says Dr Martin Scurr

This means that they act on receptors in the brain that respond to the chemical messenger acetylcholine. Low acetylcholine levels are characteristic of dementia.

Long-term use of other medications that block these receptors, including antipsychotics and some antidepressants, is also associated with an increased risk of dementia.

Cetirizine is actually a weak anticholinergic, so the twice-weekly doses are not a problem. However, it is not good for feeling drowsy.

My advice would be: limit the pills, only go to bed when you are sleepy, get up if you can’t sleep, don’t read or watch TV in bed – it’s only for sleeping, get up at the same time every morning and don’t nap during the day.

After an x-ray I was diagnosed with a heel spur. My GP referred me to a podiatrist. I am waiting for an appointment, but I am in a lot of pain. I use podiatric felt and heel supports in my shoes, but this does not relieve the discomfort.

Owen Rees, Devon.

Dr. Martin Scurr responds: Calcaneal, or heel spurs, are bony growths on the calcaneus, the heel bone. They can be asymptomatic and are often noticed during an x-ray taken for other reasons. They can also be acutely painful, even disabling.

They occur as a result of prolonged stress on the ligaments in the foot, for example due to gait abnormalities, poorly fitting shoes, obesity, osteoarthritis or plantar fasciitis (inflammation of the tissue that connects the heel bone to the ball of the foot).

This causes inflammation, to which the body responds by building up bone as a protective mechanism. Treatments include padding – heel supports may not help much, but a podiatrist can provide a better version, in the form of orthopedic insoles.

Your GP may also prescribe a nonsteroidal anti-inflammatory drug (NSAID) such as diclofenac. You will need to continue this treatment for at least six weeks. The next stage is a corticosteroid injection, usually administered using ultrasound to precisely locate the problematic area. But be aware that this is given to suppress inflammation, rather than to remove the spur itself.

An orthopedic specialist may suggest Botox injections to “paralyze” the muscles in the sole of the foot. This takes pressure off the inflamed area, allowing it to heal.

In extreme cases, patients may be offered surgery to remove the spur. However, most patients find that their pain resolves with more conservative methods and the need for surgery is still unproven.

I would caution against other experimental treatments, including shockwave therapy and ultrasound. These are widely advertised for these types of problems, but in my opinion are a waste of money.